Reading My Explanation of Benefits
After your hospital visit you will receive many different medical
bills from your providers and an explanation of benefits from your
insurance company. It is important to review and keep these
documents. Below are some tips that will help you better understand
how to determine what you owe:
1. Read each bill and explanation of benefits carefully. If you
have any questions, call the customer service number on the bill
and/or explanation of benefits.
2. Separate your bills from your explanation of benefits.
- Make a separate stack for each hospital, doctor, or insurance
3. Match the hospital and doctor bills to their corresponding
explanation of benefits.
- Take one of your hospital or doctor bills and find the date of
service and the amount of the charges.
- Then, look through
your explanation of benefits and find the one or ones if you have
multiple insurances that have a matching service date and charge
- Clip them together.
4. You will need to determine if the bill is paid in full or if
there is a balance due.
- The explanation of benefits will tell you if the charge was
paid by your insurance provider; how much they paid; if the charge
was denied or is pending; and what amount was applied to your
deductible and/or co-insurance.
- The explanation of benefits
will also tell you if your insurance company needs additional
information such as accident details to finish processing your
5. Is the bill paid in full? If yes, file it away in a folder or
pocket of an accordion folder labeled "Paid In Full."
6. If the bill is not paid in full and the bill is awaiting
insurance payment, file it in a folder or pocket of an accordion
folder labeled "Needs Payment from Insurance Company."
Follow-up with your insurance company on these balances and provide
any additional information that is needed to process your claim.
7. If the bill is not paid in full and the bill is awaiting payment
from you, file it in a folder or pocket of an accordion folder labeled
"Needs Payment from Me." These are the balances you need to
pay the provider.
- When payment has been made, move the bill to the "Paid In
Full" pocket or folder.
8. Remember to call your insurance company if they do not pay your
claim within 30 days from the date you received services.
9. Follow these same steps to match the rest of your hospital and